Getting Help From Psychiatric Meds: Then, Now, Maybe Forever

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Long ago and far away, I was married to a family physician. I had two sparkly-eyed, adorable daughters, aged almost 2 and 5. I still breastfed the younger and was privileged to stay home. Both girls were born at home, in rural Oregon with a nurse-midwife. Our house was perched atop a hill overlooking a valley ablaze with flowering cherry, pear, and apple trees in spring, with lush and weighty fruit ripening in summer. The neighbors spanned the next hill, wine grapes covering their verdant turf. This was the early ‘90s, and that house was my beautiful prison.

I felt anxious, obsessively so, and miserable— depressed. I woke each day after my husband left for clinic, my daughters clambering up to my bed in frilly cotton nightgowns, ready for their day and full of energy. I wondered how I could make it through each endless dreary hour until bedtime came that night.

As a nurse-midwife, I knew most of what there was to know about women’s reproductive health—or so I thought. But no one had taught mental health. At Yale, where I graduated with a master’s in nursing, one of my most brilliant faculty had faced mental health issues following a first birth. Her illness (or its treatment) proved so severe her face became lax and erased of expression, and she appeared zombie-like and eerie, compared to her prior vivacious spirit. Then, she disappeared from teaching with scarce a trace. Swssh swssh, it was whispered, no one knowing the true story. Postpartum mood and anxiety had all but no evidence base or treatment back then. Ergo, in modern medicine, it didn’t exist. There was little room for women’s experience if it hadn’t been “proven” by the (mostly white, male) canon of medicine.

Anxiety, insomnia, and depression wracked me in the last trimester with Rivkah, my second (I’d later learn late pregnancy symptoms signaled a high risk of postpartum issues). My husband’s colleague Tina, a warm family doc, prescribed sleep aids known to be OK in pregnancy. I assumed I would feel better after the birth, but my baby was colicky. I grew anxious, irritable, obsessed about what I’d said (or not) to the clerk in the Safeway, and often too wound up to sleep, waking in the dark hours with a pounding heart, panicked for no reason.

My then-husband’s only answer (he was doing the best he could) was to work roughly 12 hours or more each day and, when I cried or anguished, insist, “It’ll get better!” It’s amazing how long I believed him. As if he had some special foreknowledge or prescience about the future, and could guarantee improvement. He was depressed, too, a lifelong, intergenerational condition he “treated” with workaholism. It took me years to realize, “It’ll get better!” was all he knew and not the truth.

To escape the house, I leveraged connections in our small-town medical community and wrangled a part-time job seeing outpatients at the practice where my husband worked. As the sole female provider joining a group of male family physicians, women flocked to me for annual exams. We would dispense with the physical part of the exam rather quickly but spend a long time talking. Talking about where these women were in their lives and where they wanted to go. What obstacles lay in their path, and how they could clear them. I failed to see parallels in my own life, simply caring for others as I always had.

Work helped, but I still obsessed about inconsequential patient details or what I’d said to a friend. And the lack of sleep was mind-numbing, beyond cranky-making. Life was not fun—not at all. I worried how my moodiness and irritability could affect my kids—I obsessed about this, actually. I was obsessed about obsessing! I didn’t know to call this anxiety or depression. Wasn’t depression when you couldn’t get out of bed? On the contrary, I could hardly stay in bed, was going to work and taking care of kids, “functioning.” It just all felt like a big grey slog.

I started to see something intriguing at work. One physician (who, hush-hush, not to be shared and I don’t know how I knew) had a history of depression and tried and benefitted from Prozac. He subsequently put a number of patients on selective serotonin reuptake inhibitors (SSRIs). (By this point, 1996-ish, Zoloft, Paxil, and Luvox had also hit the market.) I started recognizing depression in my patients and prescribing SSRIs. I watched people get better. Like, way better. “I feel like myself on a good day, almost every day,” they would tell me. The societal Kool-Aid associating mental health issues with weakness and shame no longer made sense. This was a bona fide disorder that responded to treatment as well as infections, hypertension, or asthma. I saw it every day.

Finally, I phoned a friend in the city; someone I’d met on Labor & Delivery when she was a med student and I a nurse-midwife. She was a psychiatrist. I admitted my symptoms. “I think you’re depressed,” she said, confirming what even I now knew. She referred me to another psychiatrist who practiced women’s mental health—a nascent specialty at the intersection of psychiatry and obstetrics.

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I don’t remember exactly what the psychiatrist asked in that initial visit or even my response. But I remember not making it through my first sentence without weeping, crying for a long time, spewing out my tale. The psychiatrist, petite, well-dressed, and calm, just nodded. She sat silent and affirming until I finally paused to suck in a ragged breath. A wash of relief flowed through me. I felt seen, heard.

I stopped breastfeeding that week and began antidepressants (we didn’t yet know women and babies can tolerate SSRIs just fine in lactation; even usually in pregnancy). Magically, my 5-year-old’s behavior suddenly improved. (Research shows when mothers get treated, children’s behavior and emotional issues improve. It may not be fair but is true: When Mom’s happy, everyone’s happy.)

As I recovered, one of my first realizations was, “I can leave my husband if I need to!” I was my former, energetic self, just as my patients were. I could escape my beautiful prison if it proved best for all of us. I stayed half a dozen more years, but that initial wash of wellness proved life-transforming—to feel agency and strength again, to no longer feel beaten down by misery.

That was 28 years ago. I have been on several antidepressants since. (Yes, there are sometimes side effects, but, contrary to popular belief, they can usually be ameliorated.) I tried, early on, to wean myself off—“I don’t need these, I can do this!”—and quickly regressed into that familiar, ugly, anxious sleepless pit. I learned “depression” didn’t often mean inability to get out of bed, but could mean poor sleep, lack of joy, guilt-addled poor concentration, low energy, and more. And if a person has three or more lifetime episodes of depression, maintenance meds are recommended. Also, women rarely experience depression without clinically diagnosable anxiety, for which antidepressants are the standard treatment as well. If you need meds, you need meds. No shame in that at all.

Instead, shame on anyone who tries to tell you otherwise.